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The paroxysm consisted of simultaneous hypertension and tachycardia associated with sweating and facial pallor during the absence attack. We suggest that this is secondary to a generalised increase in sympathetic activity causing vasoconstriction and increased cardiac output. This is supported by (a) increased MNSA and heart rate despite progressive rise in blood pressure; (b) symptomatic blood pressure overshoot; (c) noradrenaline increased to over seven times the normal tilt levels; (d) prominent low frequency (0.1Hz) oscillations in blood pressure and MNSA during recovery.2 These low frequency oscillations (0.1 Hz) are thought to be secondary to changes in brain stem sympathetic activity separate from the effects of respiration, which are generally of a higher frequency (0.2 Hz).

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